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A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa
Background
Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa.
Methods
The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.
Results
Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52;
p
= 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating.
Conclusions
This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes.
Trial Registration
Current Controlled Trials
ISRCTN11275465
; Registered 29 January 2007 (retrospectively registered)
Journal Article
The heart of the matter : music and art in family therapy
\"The Heart of the Matter invites therapists from all disciplines to consider the use of music and art in their work with families. It introduces systemic music and art ideas, giving clinical examples from practice, and a rationale for using each technique. Conversations with therapists who have explored and incorporated the techniques into their work are shared, and include both personal and professional responses to incorporating new methods in practice.\" -- Publisher's description.
Book
A six-week group program of emotion focused family therapy for parents of children with mental health challenges: protocol for a randomized controlled trial
Background
Children with mental health difficulties are at increased risk of many adverse psychological, academic, and social outcomes. Emotion regulation is a key transdiagnostic factor in the development and maintenance of mental health challenges. Parents and the family system (e.g., parental functioning, parenting, parent-child relationship) play a central role in children’s development of emotion regulation and, in turn, their mental health. Therefore, continued efforts are needed to understand the effectiveness of emotion-focused treatments for child mental health difficulties, particularly those that include a family-based approach. Emotion Focused Family Therapy (EFFT) is an intervention for parents of children with mental health difficulties that teaches parents advanced skills to support their child’s emotional development, potentially leading to improvements in the psychological functioning of the affected child as well as the family. Despite this, EFFT’s efficacy has yet to be tested empirically via a randomized controlled trial.
Methods
A six-week group modality of EFFT was developed based on the standard manualized version of a two-day group modality of EFFT. Efficacy of the six-week group modality of EFFT will be tested in a randomized controlled trial among parents of children aged 7 to 15 with anxiety, depression, or behavioral challenges. Parents will be randomized to the intervention condition or waitlist control condition. Online questionnaires and in-lab assessments will be conducted at pre-treatment, post-treatment, 4-month follow-up and 1-year follow-up. Intervention effects on primary (parent psychological symptoms, child psychological symptoms, parent emotion regulation, child emotion regulation, parent-child co-regulation) and secondary (parental emotion socialization, parent emotion blocks, parental self-efficacy, perceived parental stress, treatment satisfaction, treatment fidelity) outcomes will be analyzed by linear mixed models.
Discussion
The study protocol describes the randomized controlled trial of EFFT, a parent group intervention for parents of children with anxiety, depression, and behavioral challenges. Findings contribute to the understanding of the efficacy of EFFT as a time-limited, transdiagnostic intervention for the treatment of child mental health challenges with potential positive impacts on parent and family functioning.
Trial registration [2a]
ClinicalTrials.gov: NCT05603000. Prospectively registered October 13, 2022.
Protocol version [3]
Version 1.1 November 2023.
Journal Article
Stakeholder perspectives on contextual barriers to the successful implementation of multiple family group therapy in the Lower Manya Krobo District, Ghana: a qualitative study
ObjectiveThis study aimed to examine the contextual barriers that may hinder the implementation of multiple family group therapy (MFGT) in Ghana’s Lower Manya Krobo District.DesignAn exploratory, descriptive, qualitative study employing focus group discussions and in-depth interviews.SettingAtua Government Hospital in the Lower Manya Krobo District. Data were collected between February and March 2025.Participants12 young people living with HIV (YPLHIV; aged 12–22 years), 13 caregivers and five healthcare professionals were selected via purposive sampling.ResultsFour major themes emerged: (1) resource and logistic constraints, including transportation challenges, programme sustainability concerns and inadequate physical facilities; (2) stigma and confidentiality concerns, encompassing public identification fears and community stigma; (3) implementation challenges, involving attendance reliability and organisational instability; and (4) participation barriers, including group setting anxiety and delayed HIV status disclosure. These barriers spanned multiple domains of the Consolidated Framework for Implementation Research (CFIR), highlighting the complex, multi-level nature of implementation challenges.ConclusionSuccessful implementation of MFGT for YPLHIV in Ghana requires addressing interrelated barriers across multiple ecological levels simultaneously. These findings largely underscore the importance of exploring the local context for potential barriers to inform the adaptation of evidence-based interventions to accommodate ecological concerns.Trial registration numberNCT06701942.
Journal Article
The effectiveness and cost-effectiveness of attachment-based family therapy for young adults with high suicidal ideation: protocol of a randomized controlled trial
Background
Young adult suicidality is worldwide a prevalent mental health problem and the number one cause of death, with devastating consequences for individuals and their families, and substantial economic costs. However, psychological and pharmacological treatments currently recommended in guidelines for treatment of high-risk youth for fatal suicide have limited effect. In line with the World Health Organization’s (WHO) recommendation to involve the family in treatment of these youth, attachment-based family therapy (ABFT) was developed, a 16-week attachment and emotion-focused treatment, implemented in mental health care settings across various European countries in the past years, and becoming increasingly popular among therapists. However, the (cost-)effectiveness of ABFT has not been studied in emerging adults. In the proposed pragmatic randomized controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of ABFT compared to treatment as usual (TAU) on suicidality, as delivered in daily practice.
Methods
This pragmatic multicenter study in the Netherlands and Belgium includes 13 participating sites. Participants are suicidal young adults (≥ 31 SIQ-JR score) between 16 and 30 years old who seek mental health treatment (
n
= 142) and their caregivers. The primary outcome is suicidality (SIQ-JR), with assessments at baseline, post-intervention (5 months after baseline), 3, 6, and 12 months after intervention. We predict that, compared to TAU, ABFT will lead to a stronger reduction in suicidality and will be more cost-effective, over the course of all time points. We also expect stronger decreases in depressive symptoms, given that suicidality is very common in individuals with depressive disorder, as well as more improvement in family functioning, autonomy, entrapment, and young adult attachment, in the ABFT condition.
Discussion
This study can contribute to improving the care for suicidal youngsters with high mortality risk. Treatment of suicidal emerging adults is understudied. The results will inform clinical guidelines and policy makers and improve treatment of suicidal emerging adults.
Trial registration
This trial is registered on ClinicalTrials.gov (NCT05965622, first posted on July 28, 2023).
Journal Article
Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study
Background
Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted.
Methods
One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out.
Discussion
We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome.
Trial registration
ClinicalTrials.gov,
NCT03350594
. Registered on 22 November 2017. IDRCB number 2016-A00818-43.
Journal Article